Postural instability/gait disturbance in Parkinson's disease has distinct subtypes: an exploratory analysis
| Autor: | Eric Molho, N. Kyle Steenland, Donald S. Higgins, Cyrus P. Zabetian, Denise M. Kay, Haydeh Payami, Jennifer S. Montimurro, Ami Rosen, Stewart A. Factor |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Parkinson's disease Genotype Cross-sectional study Poison control Neurogenetics tau Proteins Logistic regression Article Central nervous system disease Apolipoproteins E Risk Factors Internal medicine medicine Humans Gait Postural Balance Aged Polymorphism Genetic Gait Disturbance Parkinson Disease Middle Aged medicine.disease Psychiatry and Mental health Cytochrome P-450 CYP2D6 alpha-Synuclein Physical therapy Female Surgery Neurology (clinical) Psychology |
| Zdroj: | Journal of Neurology, Neurosurgery & Psychiatry. 82:564-568 |
| ISSN: | 0022-3050 |
| Popis: | Objective To test the hypothesis that postural instability with falling (PIF) and freezing of gait (FOG) are distinct subtypes of the postural instability/gait disturbance (PIGD) form of Parkinson9s disease (PD). Methods 499 PD subjects from the NeuroGenetics Research Consortium were studied using logistic regression to examine, in a cross sectional analysis, predictors of FOG and PIF. Potential predictors were from four spheres; demographic, clinical motor, clinical non-motor and genetic. Results FOG and PIF were both associated with greater gait subscores and lower tremor subscores on the Unified Parkinson9s Disease Rating Scale (p≤0.02). However, they differed with regard to demographic, non-motor and genetic predictors. FOG was associated with greater duration of disease, with ORs of 3.01 (95% CI 1.35 to 6.72) and 4.91 (95% CI 2.29 to 10.54) for third and fourth quartiles of duration, respectively, versus the lowest half of duration. The risk of having psychotic symptoms was also significantly increased (OR 3.02, 95% CI 1.41 to 6.49; p=0.004). FOG was inversely associated with the presence of the CYP2D6 *4 allele (OR 0.41, 95% CI 0.21 to 0.80; p=0.009) suggesting a protective effect. PIF was associated with depression (OR 1.08, 95% CI 1.01 to 1.15; p APOE ɛ4 (OR 0.21, 95% CI 0.05 to 0.87; p=0.03), again suggesting a protective effect. Conclusion FOG and PIF have different demographic, non-motor and genetic predictors suggesting that they may be pathophysiologically distinct subtypes of PIGD. These findings have implications in the discovery of therapeutic targets for these disabling features as well as for predicting outcomes of PD. |
| Databáze: | OpenAIRE |
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